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Organization
NKE NEW LEAF LLC
Active
Organization
NKE NEW LEAF LLC
Active
Other names
New Leaf Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
NOE ANTONIO LOPEZ (CEO)
(915) 313-4114
Entity
Organization
Contact information
Practice address
10921 PELLICANO DR STE 110, EL PASO, TX 79935
(915) 313-4114
(915) 313-4939
Mailing address
10921 PELLICANO DR STE 110, EL PASO, TX 79935-4604
(915) 313-4114
(915) 313-4939
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
66155
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2915829
—
TX
05
—
3898868
—
TX
Enumeration date
11/06/2012
Last updated
09/01/2021
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